There’s been much talk in Cape Town at Forum 2012 over the past week of the need for a paradigm change in thinking about health research for development.

Certainly the concept is a useful one to describe the switch from an approach focussed primarily on the allocation of research resources, to one that addresses the need to build systems of innovation in the health field (as elsewhere).

It helps us move beyond a fixation with the famous 90/10 imbalance between research expenditure on developed and developing world health priorities, to embrace a wider perspective.

But at the end of three days of lively discussions, I remained unclear whether talking about “Beyond aid” – the theme of the meeting – represented a radical idea, or a useful way of labelling a set of trends that have been in motion for some time, and identifying the general direction in which they point.

Either way, however, such a discussion is timely.

First, as Carl Ijsselmuiden, executive director of the Council on Health Research for Development (COHRED), the main organiser of the conference, pointed out in his opening remarks, it captures the growing feeling that “foreign aid as hand-outs to the poor” is no longer workable.

The approach may not be one that wins many votes for aid-providing governments. But in the long-term, these realise that “foreign aid as capacity building” is much more likely to produce lasting results.

Second, talking about what happens next – particularly in an area such as health research and innovation, and at a time when external sources of funding are drying up – provides a spur to developing country governments to address their own responsibilities.

Ending on an up-note: the singer Princess Chaka Chaka, UN Goodwill Ambassador and a champion of Africa's fight against malaria, leads participants of Forum 2012 in a farewell chorus (Gabi Falanga)

This has both funding and policy implications. Health research spending needs to become a higher priority for these governments. And they need to create the incentives that will allow the result of this research to be translated into medical products – such as drugs – and services.

Finally, there is the pragmatic issue that, as aid budgets start falling in many developed countries as a result of their financial difficulties, anything that promises to “do more with less” with what funding remains available becomes increasingly attractive.

Moving from “aid as hand-out” to “aid as capacity building” does just that.

So, three good reasons for embracing the concept of a paradigm change. But it also became clear in the Forum 2012 discussions that there are reasons for not expecting too much, too soon.

There may be consensus on what needs to change. But this consensus does not necessarily extend to agreement on what this change should be.

Pharmaceutical companies may agree that this is a challenge. And that they need to work with governments – and aid agencies – to tackle it. But their interests ultimately lie in benefitting from the market, not in seeing alternatives put in place.

Similarly health ministers may be persuaded of the arguments for developing home-grown health industries, better equipped to meet local health needs.

But the people who really need convincing work in finance ministries. And the financial case for operating in a new way, rather than, for example, just importing technologies from abroad, is not always self-evident.

Paradigms get embedded in social – and political – systems. Changing them is not just a question of rational debate (even in science). It also requires challenging the interests that the old paradigm served. And it can have costs attached.

So, big challenges ahead. The major contribution of Forum 2012 was to help cement the idea that “aid for capacity building” is the new mantra that needs to frame aid and government policies, in developed and developing countries alike.

Also that, as in fields such as agriculture and energy, health needs to move away from the idea that developments are research-driven, to recognising that research is one component of a holistic system of innovation – each part of which needs to be addressed.

The immediate task, as always, is to work out what all this means in practice, identifying needs and opportunities, and assessing the potential contributions of all interested parties (including the media).

Not quite the “Beyond aid” vision that the organisers are aiming for. But a step in that direction.

David Dickson is editor of SciDev.Net

This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012.

African countries are being asked to use science, technology and innovation to create different, more inclusive forms of wealth that benefit entire societies and are more sustainable.

Under-development on the continent can be addressed by reduced reliance on inherited forms of wealth such as oil and minerals, and by shifting to “created” wealth through the application of science, technology and innovation, the Africa ST&I forum heard on its final day today.

“Science and innovation will create not only sustainable but equitable wealth for all in Africa,” said Donald Kaberuka, head of the African Development Bank (ADB) at the ministerial session of the forum.

“Created wealth has the potential to accelerate development and reduce inequality, as opposed to inherited wealth which fuels inequalities and at times sparks conflict in Africa,” he added.

Kaberuka said the bank has identified and is funding ST&I initiatives aimed at spurring economic development on the continent, alongside its investments in other sectors such as water, energy and infrastructure development.

He advised universities in Africa to place greater emphasis on e-learning education approaches, to help bridge the gaps resulting from a continent-wide shortage of qualified lecturers and the high number of university students.

“It would make a lot a sense to use e-learning in universities instead of having one lecturer teaching 1,000 students, resulting in poorly qualified graduates,” Kaberuka said.

By 2030, Africa stands to benefit from “demographic dividends”, as it is estimated a quarter of the world’s youth population will be Africans – but the opportunity to take advantage of this workforce will be lost if they don’t receive the education and skills training necessary to innovate and become entrepreneurs.

The ADB boss noted that some Asian counties have effectively utilised their large youth populations, with deliberate strategies to provide skills training and jobs, and said African countries need to perform the same task.

UNESCO director Irina Bokova told the meeting that UNESCO is helping African countries draft and reform their STI policies to align them with demands of current times, with a particular focus on grants and rewards for innovations for young scientists and women.

In an evening of a cosy buffet and free flowing drinks, many at the Forum’s conference dinner discussed Africa’s love of conferences and the lack of implementation of their outcomes.

Kenya’s Minister for Higher Education Science and Technology, Margaret Kamar, who was the host, could have not been more apt in terming the continent “a sleeping giant with tons of declarations with nothing being done to fulfil them.”

And she said she hoped that at the end of the Africa Forum on Science, Technology and Innovation that scenario would change.

“I hope tomorrow will mark the end of declarations for Africa and we must translate these outcomes into development,” she said.

She had some food for thought for the delegates, that unlocking the continent’s potential won’t come from meetings and resolutions but on the ability of her people to wake up the giant and give it the much needed push to development.

“It’s time for science, technology and innovation in Africa and there is no short cut. We must do it. We want solutions that will work. Practical solutions for practical problems,” Kamar said.

The dinner was also a chance for delegates to relax after a long day’s deliberations, with African beats belching out from big speakers. There was talents galore in footwork, and some very intricate and rare dance steps. It was a reminder that everyone there, irrespective of their stations in public life — academics, diplomats, and even journalists like me — have many other gifts… including dancing.

Nonetheless, Kamar’s remarks echoed what has been said in many other places, at other meetings in other posh hotels, where excellent declarations have been made that rarely translate into tangible solutions for Africa’s people, the majority of whom are trapped in abject poverty.

Africa can only come unstuck with a paradigm shift, not business as usual.

We are now waiting to see how — and whether — this Nairobi meeting that had at its theme the promotion of Youth Employment, Human Capital Development and Inclusive growth will contribute to bringing about real change.

More laboratories for companies offering science and technology solutions and products targeting African challenges need to be located in Africa, in order to make these services more affordable to African consumers, the African Forum on Science, Technology and Innovation has heard.

At a plenary session today, rapporteurs read out out recommendations made at each session from the first two days of the forum — which have included a series of parallel meetings today on topics ranging from water and sanitation, to E-health and food security. The recommendations will be discussed at the ministerial meeting on the final day of the forum tomorrow.

Delegates at the plenary heard that as well as improving affordability, the presence of such laboratories would improve the ability of researchers and students to access relevant knowledge.

Rapporteurs said delegates had commented that the concentration of high-tech facilities in the western world and parts of Asia were failing to benefit African innovators, especially in the area of knowledge-sharing — with distance cited a significant factor.

“High-tech labs are out of reach of many African innovators and scientists” was one conclusion read out by Thierry Ammoussougbo, rapportuer and staffer with the UN Commission for Africa (UNECA). “Many firms selling products here do not make their products in Africa,” he continued.

The forum has heard calls for better training and working conditions to encourage African scientists to stay on the continent.

The first two days of the Forum have also been characterised by general calls for an African Science Academy to be established to boost ST&I on the continent and nurture young talent.

While funding for such an initiative could potentiall be sourced from international donors, many delegates have said that African states need to fund ST&I work in their respective countries in order to retain control over the funding and direction of various disciplines.

“They must be able to raise their own funds which they can control away from relying purely on donor funding,” was a conclusion read to the plenary by Ammoussougbo.

It was further felt that a realistic plan of action that would involve the continent’s science and technology government ministers needed to be developed by each country’s delegation, in order to help move the ST&I agenda “from talk to action”.

Further, the mainstreaming of science, technology and mathematics teaching in all institutions of learning — from primary school to university — and the encouragement of experts from the African diaspora abroad to collaborate and share knowledge with the continent was recommended.

Another recommendation was for the improved training of lecturers, and the implementation of deliberate measures to improve their working conditions was necessary in order to retain African experts at home.

Finally, the plenary heard calls for the establishment of regional and national ST&I forums, and improved communication of ideas with the wider public, to encourage all Africans to better appreciate the role of science, technology and innovation in national development .

While mobile phones use has expanded at an astonishing rate in Africa, this on its own is insufficient to bring so-called E-health solutions to the millions of people living in remote, poor rural areas.

Cellphone use must be complemented by other relevant technologies, infrastructure and applications that will ensure the cost of accessing health ICT is made cheaper and cost effective, the first African conference on Science Technology and Innovation for Youth Employment, Human Capital Development and Inclusive Growth was told on Monday.

“We must never over-rely on mobile phones alone as a means of delivering E-health, and must move to other technologies such telemedicine and video conferencing — which could be a bit expensive, but whose cost can be brought down if we start manufacturing of the requisite devices here in Africa,” said Robert Jalang’o of the Multimedia University College of Kenya.

Mobile phone use has expanded enormously in Africa, but the conference heard other technologies and infrastructure is needed to roll out e-health solutions to all the continent's peoples.

Mr Jalang’o addressed a session on E-health at the conference, which is underway in Nairobi, saying that the high cost of foreign technologies must be brought down if ICT use in the sector is to be fully realised. This, he said, needed to involve undergraduate and post-graduate students in producing these technologies, which he added would not only give them specialist knowledge, but provide them with jobs as well.

Speakers at the session noted that back-up infrastructure — such as transmission masts and solar power facilities to power the stations and handsets — must also be in place to serve people living in the most remote regions of the continent.

While it was agreed that mobile phones should not be over-relied on to deliver health solutions, there was a consensus at the session that these gadgets will be the most popular option to deliver E-health in rural Africa into the foreseeable future.

As a result, the participants said, there is a need to make addressing the challenges relating to access a priority at all levels — not just for policymakers.

“Let’s teach our people how they can develop content for e-health even at grassroots level as well, so that through using [mobile] phones they can share their expertise in fields such as indigenous health knowledge,” Muhammadou Kah, vice-chancellor of the University of the Gambia, told the session.

He said involvement in generating content for e-health solutions should engage people at village level, noting that locally-produced content would be the most relevant in addressing local health needs.

It seems the disagreements surrounding the selection of the Pan-African University (PAU) node for the Southern Africa region are far from being over; at least that was the impression I had as Beatrice Njenga of African Union gave a rundown of the project to the conference today.

South Africa’s Stellenbosch University had been chosen to host the space sciences centre but there were concerns by other regional countries who claimed they were not consulted — and also that they would have preferred to host a centre on water issues.

Alfred Watkins, executive chairman of Global Innovation Summit had some interesting sentiments on the broader issue of investing in science in Africa.

He lamented widespread inertia when it came to the need for “practical solutions for practical problems,” and added that “vision with no implementation was mere hallucination”.

The same sentiment had been expressed earlier in the morning by Kenya’s Minister for Higher Education, Science and Technology, Margret Kamar.

“Africa is full of declarations we must now move to action,” she said.

According to a UNESCO report, Sub-Saharan Africa has seen growth in recent years in science and technology, particularly in the areas of internet access due to the explosion in mobile phone use, and I’ll have more to say on that in another blog post.

The African Conference on Science, Technology and Innovations for Youth Employment, Human Capital Development and Inclusive Growth opened in Nairobi on Sunday with calls for tangible action to use science and technology to fight youth unemployment and poverty.

Speakers at the first day of the conference said the time had come for the continent to use knowledge already in its possession to tackle these double malaises which continue to afflict the continent even as scientific and technical advances continue to be made around the world.

“It is now quite clear that the ability of African countries to achieve rapid and inclusive development and [the] ability to compete in the global market lies in their ability to use science and technology and to creatively innovate, ” said Margaret Kamar, Kenya’s Minister for Education, Science and Technology.

“It is only through this that Africa governments will be able to address some of the most pressing challenges of human capital development and youth unemployment,” said the minister at the opening of the conference.

The forum — the very first of its kind in Africa — is sponsored by the United Nations Education and Science Council (UNESCO) and the African Development Bank (AFDB).

It aims to generate concrete steps and points of action including a “Nairobi Declaration” on a way forward that addresses the conference’s main themes and the measures that need to be taken to actualise the dream of African economies driven by ST&I.

Delegates include government ministers, bureaucrats and civil society activists and representatives from the private sector.

Lamine Ndiaye, President of the African Academy of Sciences urged the continent’s governments to increase funding for ST&I, saying the traditional apathy of funding for ST&I would not work for Africa.